Provider Demographics
NPI:1639513138
Name:CHERRY, KAMA (RN)
Entity Type:Individual
Prefix:
First Name:KAMA
Middle Name:
Last Name:CHERRY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:85 BENTWOOD DR APT 6
Mailing Address - Street 2:
Mailing Address - City:WATERBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06705-3618
Mailing Address - Country:US
Mailing Address - Phone:203-519-2992
Mailing Address - Fax:
Practice Address - Street 1:85 BENTWOOD DR APT 6
Practice Address - Street 2:
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06705-3618
Practice Address - Country:US
Practice Address - Phone:203-519-2992
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-26
Last Update Date:2013-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT102812163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse